Fractures Bio Med 4
Transcript of Fractures Bio Med 4
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Fracture Management
Bio Medicine Emergency MedDr. Spencer Shimabukuro
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Fracture Management
Introduction
Rarely life-threateningProper handling can reduce the amount of
pain
Future function may depend on how the fracture
was handled
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Life or Limb
Threatening Emergencies
ConditionOpen fracture
Fracture/dislocation
with major vasculardisruption
Major pelvic fracture
Hip dislocation
Compartmentsyndrome
Possible outcomeOsteomyelitis
Amputation
Exsanguination
Avascular necrosis ofthe femoral head
Ischemiccontracture, renal
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Compartment Syndrome
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Compartment Syndrome
A potential emergency condition where excesspressure builds up in an enclosed part of the body(or compartment)
The pressure may cut off blood to affected tissues
May kill organs and tissues leading to amputation andeven death
May lead to irreversible muscle and nerve damage
Legs, arms, and abdomen are most prone to
compartment syndrome
Usually due to injury/wound such as a brokenbone
May take just several hours to develop
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Fractures & Dislocations
Fracture: A break in a bone produced by
excessive strain or force on the bone.
Causes include a blow, a fall, a twistingmovement, or even no apparent cause
(spontaneous fracture).
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Types of Fracture
Open Fracture (compound): has penetration ofthe skin and bleeding.
Closed Fracture (simple): has the skin intact.
Stress Fracture: is a small fracture usually in aweight bearing bone It is an overuse injury that is caused when
muscles fatigue and excess physical stress istransferred to a bone.
Tibia - runners Tarsals, calcaneus, and toes of the feet runners
Vertebrae osteoporosis and cancer
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CLASSIFICATION OF
FRACTURES
Types of Fractures Transverse - fracture runs
perpendicular to the axis ofthe bone
Greenstick in youth, bonebends and breaks
Oblique fracture runs atan angle to the axis of thebone
Comminuted bone isbroken into several pieces(at least 3 different pieces)
Stress bones fracturesdue to pressure or stressput on it
Spiral due to twistingmotion
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DISLOCATION
Dislocation: is a separation or displacement ofjoint, with a structural loss of joint stability.
It may or may not be accompanied by a fracture(fracture-dislocation).
It is usually caused by an injury such as a hardblow or fall.
Treat a dislocation as a fracture, and seek
medical attention immediately. You can cause a lot of damage by trying to re-
inserting a dislocation yourself
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PERIPHERAL FRACTURES
Mechanisms of Injuries
Variety of Forces
If biomechanics is known it may be possible to
predict.
Direct blow: injury at the point of impact.
Indirect blow: injury caused did not occur at the
point of impact, but rather at a point somedistance away, due to forces transmitted along
the bone.
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PERIPHERAL FRACTURES
Mechanisms of Injury
Twisting Forces: typically the distal part of the
extremity remains fixed while torsion develops in
a more proximal part of the limb. Commonly occurs in football or skiing.
Violent muscle contractions
Avulsion fractures Fatigue/stress fractures
Pathologic conditions
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PERIPHERAL FRACTURES
Signs and Symptoms
(General)
Pain at fracture site
Patient heard the bonesnap or pop.
Deformity or unnaturalmovement
SHORTENING of theextremity.
Swelling/bruising Guarding/loss of use
Crepitus
Exposed bone ends
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PERIPHERAL FRACTURES
Initial Treatment
Keep the patient still
ABCDS
Call 911
Observe for signs of hypovolemic shock due to
internal bleeding
Immobilize broken bones and joints Prevent further injury
Minimize pain and discomfort
Reduce swelling and bleeding
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How to Test for Fractures
A 128 Hz tuning fork canbe used to test forfractures
Hit the tuning fork to
cause it to vibrate Place on potential fracture
The vibrations will vibratethe bones and cause it to
hurt About 80% accurate Mostly accurate on long
bone and ribs
May miss the toes the
most
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PERIPHERAL FRACTURES
Splinting
Splints are applied to suspected fractures,dislocations and severe sprains.
The objective is to immobilize the joints aboveand below the injury.
Applying a splint reduces the movement ofinjured muscles and bones, and allows the
patient to be transported with less pain and riskof further injury.
It also reduces the risk of shock by decreasinginternal bleeding.
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PERIPHERAL FRACTURES
Splinting
Splints can be made from a variety of rigid or
firm materials, including cardboard, a tree
branch, a broom handle, or a tightly rolledblanket or magazine.
An injured limb can also be protected by
Buddy Taping it to another part of the body.
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PERIPHERAL FRACTURES
Splinting Procedure1. Explain the procedure to the patient.
2. Check PMSC (pulse, motor, sensory & capillary refill) before & aftersplinting.
3. Control any bleeding, expose the fracture site by cutting clothing &removing shoes & socks (except for ankle/foot injuries). If you are
splinting an upper extremity injury, remove rings, watches or otherjewelry.
Swelling may make it difficult to remove jewelry at a later time.
4. Control bleeding
5. Select an appropriate splint that is longer than the bone it will need tosupport.
Measure the splint against the uninjured limb to obtain anapproximation of the correct splint size.
6. Pad the splint with soft materials to relieve local pressure.
7. Apply the splint Use tape or binding to secure the splint in place above & below
the injury site
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PERIPHERAL FRACTURES
Treatment
Record status ofdistal pulse
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PERIPHERAL FRACTURES
Treatment
Record status ofcapillary refill time
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PERIPHERAL FRACTURES
Treatment
Record status ofdistal sensation
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PERIPHERAL FRACTURES
Treatment
Record status ofdistal motion
Record status of
distal strength
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PERIPHERAL FRACTURES
Treatment
Splint joints as found
Do not try to realign a broken bone or reduce a dislocationyourself. You may damage the joint, muscles, nerves orblood vessels or even fracture a bone.
Do not push bone ends back beneath the skin.
Immobilize the joints above and below the injury. Try not to move a victim unless absolutely
necessary. Immobilize all fractures before moving the patient.
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PERIPHERAL FRACTURES
Treatment/Splinting
Pad rigid splints
generously
Leave distal pulses
and fracture siteaccessible
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PERIPHERAL FRACTURES
Splinting
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PERIPHERAL FRACTURES
Treatment/Splinting
Reassess distalpulse
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PERIPHERAL FRACTURES
Treatment/Splinting
Reassess distalsensation
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PERIPHERAL FRACTURES
Treatment/Splinting
Reassessmotor/strength
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PERIPHERAL FRACTURES
Treatment
Elevate the injured extremity if possible
Apply cold pack
When in doubt, splint
Continue to reassess vascular and neurologic
status after splinting
DO NOT give the victim food or fluids.
This may delay any necessary surgery.
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Specific Fractures:Assessment and Treatment
Shoulder
Clavicle fracture
Scapula fracture
Acromioclavicular separation
Signs and Symptoms Dropped shoulder
Holding arm across the chest
Inability to raise arm
Point tenderness
Distal numbness
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Specific Fractures:
Assessment and Treatment
Shoulder
Treatment
Have the patient sit or lie down
Support arm
Sling and swath; position of comfort; pad or pillow
under upper arm.
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Specific Fractures:
Assessment and Treatment
Humerus
Signs & Symptoms
Same as general fracturePossible wrist drop
Numbness or tingling
Treatment
Same as general splinting and
shoulder
Specific Fractures:
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Specific Fractures:Assessment and Treatment
Elbow
Signs & Symptoms (same as general)
Treatment
If arm is bent
DO NOT STRAIGHTENSling and swath
If arm is straight
Do not bend
Place pad under armpitSplint elbow
Lay patient down and elevate alarm
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Specific Fractures:
Assessment and Treatment
Forearm and Wrist
Signs & Symptoms
Same as general
Treatment
Same as general
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Specific Fractures:
Assessment and Treatment
Hand
Signs & SymptomsSame as general
TreatmentCrush Injury
Do not cleanse woundPut ball of soft cloth in patients hand
Split in bandage and imposition of functionSupport with slingObserve circulation
Closed Fracture: same as general
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Specific Fractures:Assessment and Treatment
Hip
Signs & Symptoms
Pain at sight and proximal groin
Pain and tenderness pressing on a greatertrochanter
Injured side foot turns out
Affected limb shortened
Treatment
Assess CSM
Place folded blanket between the legs
S ifi F t
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Specific Fractures:
Assessment and Treatment
Femur Signs & Symptoms
Severe pain
Loss of distal pulseShortened leg
Hypovolumic shock
Treatment
Control bleeding
Traction splint
High flow oxygen
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Specific Fractures:
Assessment and Treatment
Knee, Tibia/Fibula, Ankle and Foot
Signs & Symptoms
Same as general
Treatment
Same as general
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FRACTURE MANAGEMENT
Summary
Rarely an immediate threat to life.
A fracture can wait, the airway or severebleeding cannot.
If you do not check for neurological deficit, you
will not find it. When in doubt, treat the injury as a fracture.
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